ABO-incompatible adult living donor liver transplantation for hepatocellular carcinoma.
Living donor liver transplantation (LDLT) offers timely transplantation for patients with hepatocellular carcinoma (HCC). If ABO-incompatible LDLT is feasible, the need for pretransplantation treatment may be eliminated, which may reduce overall morbidity. In this article, we have described 8 adult HCC patients who successfully underwent LDLT from ABO-incompatible donors. Antirejection therapy included multiple preoperative plasmaphereses, splenectomy, and an immunosuppressive regimen with tacrolimus, methylprednisolone, and mycophenolate mofetil. The maintenance dose of immunosuppression did not differ from that of the ABO-identical cases. In addition, we also performed intrahepatic arterial infusion of prostaglandin E1. In 5 patients, we administered a single dose of rituximab, a chimeric CD20 monoclonal antibody. As a result of this treatment, 6/8 patients are still alive. Our experience has shown that it is possible to control antibody-mediated humoral rejection and other complications in adult ABO-incompatible LDLT.
Matsuno
N
N
5th Department of Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan. mtn@tokyo-med.ac.jp
Iwamoto
H
H
Nakamura
Y
Y
Hama
K
K
Kihara
Y
Y
Konno
O
O
Jojima
Y
Y
Akashi
I
I
Mijiti
A
A
Ashizawa
T
T
Nagao
T
T
D000017:ABO Blood-Group System; D000328:Adult; D001787:Blood Group Incompatibility; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000517:prevention & control; D006509:Hepatitis B / Q000601:surgery; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008875:Middle Aged; D009367:Neoplasm Staging; D010956:Plasmapheresis; D013156:Splenectomy; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents